Basic Information
| Provider Information | |||||||||
| NPI: | 1932664612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIPMAN | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | BLAIR | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 CENTER ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319011575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064944300 | ||||||||
| FaxNumber: | 7066602847 | ||||||||
| Practice Location | |||||||||
| Address1: | 1538 13TH AVE STE A | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319012544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063234000 | ||||||||
| FaxNumber: | 7063234848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2019 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN224459 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.